nottingham city icp...– crossing the primary/secondary care divide, community partners –...
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Nottingham City ICP
Update for HWBIan Curryer, Nottingham City ICP LeadHugh Porter, Nottingham City ICP
Nottingham City ICP progress update
• Overview of ICP and PCNs purpose• City ICP development so far• Emerging governance• Priority activities • Areas requiring further clarification• Long Term Plan overview
Reminder – the why • NHS remains a great success • Many citizens are living longer ‐ but now live with
multiple long term conditions • Expectations & capabilities also rising • Creates significant demographic and financial pressures
with a Do nothing gap locally of £xxx million over 5 years • Also requires more holistic, preventative and integrated
approaches to get better outcomes • The model of the Nottingham ICS, ICPs and PCNs is a
locally owned response to these pressures and the associated national directives
Primary Care Networks(“The Neighbourhoods”)
– Stabilise, support and improve resilience in General Practice
– Improve primary care capacity – new workforce & skill‐mix– Build relationships with local health and social care providers
– Crossing the primary/secondary care divide, community partners
– Identifying local health inequalities and building services to address them – build trust by doing
– Including feedback ‘upstream’ to commissioners/system when service gaps identified
Working at system, place and neighbourhood population levels: what should happen where (right task for the right population level)
• Integrated care provision in local teams, populations based on GP lists• Local relationships across NHS, range of providers, voluntary sector, building community
assets• Proactive case management• Predictive / anticipatory care• Local implementation to meet specific population needs
• Local Delivery structures to implement CIP / QIPP / transformation in line with ICS priorities
• Operational liaison, local system coordination, aggregation and support for PCNs• Partnership of providers, health and care, district / local level partnership working
incorporating wider determinants of health to improve health outcomes
• Overarching strategy and strategic priorities. Clinical Services Strategy and care model core requirements, SOPs where required
• Consistent clinical standards, guidelines and thresholds (e.g. diabetes pathway), health and care together
• Outcomes framework and population health management capability for all population levels – feeds ICS, ICPs, PCNs
• Single commissioner with bilateral contracts with providers, ensuring consistency of standards, core pathways, outcomes across all areas
PCN neighbourhood
working
ICP place working
ICS whole system
working
8 City PCNsestablished
City ICP development group• ICP has brought partners together in an inclusive development group• NHS, Social Care, Housing, VCS and commissioning
• Development Group becoming Executive Management Team (chair Ian Curryer)
• New Partnership Forum (Board) being agreed to start end October• Workforce Launch event on 7th November
• Appointed all 8 Clinical Directors for the PCNs, started July 2019• Appointed full time Programme Lead starting 4th November
‐ Adult Social Care ‐ CityCare‐ NUH ‐ NHT‐ Public Health ‐ Nottingham City Homes‐ Framework Housing Association ‐ Nottingham VCS‐ CCG City Locality ‐ City GP Federation‐ City PCN representation ‐ ICS Senior management‐ CCG Strategic Commissioning ‐ City Council Commissioning
Programme Priority
“Grip the City and confront the brutal facts” ‐ Financial and Performance grip on City as single view of ICP
“Manage Now and sharpen our prioritisation and focus” ‐Leadership of the City Health and Care development activities
“Set the rules of engagement and decision making” ‐ Establish great governance at the City and local PCN level
“Get behind the vision” – Focus on Change Management relentlessly
“Build the team and lead the future” – Identify roadmap for full population health management
City ICP Programme Priorities
City ICP focus areas 19/20 in more detail
• Support PCNs around Social prescribing ‐ consistent model• Improve non cancer End of life • Reduce Smoking• Improve Childhood flu vaccination uptake • Help excluded and vulnerable groups such as homelessness • Help flow – special focus on Homecare capacity and models• Mental Health inc mental health in children in schools
Expectation of PCNs• Integral component of City ICP • Clinical Director membership of ICP Exec Management Group • Clinical Director representative on the ICS Board
But we also mustn’t forget
Its also about strengthening relationships and trust • Across primary, community and secondary care• Across Health and social care• Across providers inc CVS• Across providers and citizens
As we know to really change the ‘system’ and create a sustainable health and care model in the City we need to build trust at all levels
For clarity ‐what the ICP isn’t
• It isn’t a means to an end in itself • It isn’t about privatization of the NHS• It isn’t about creating the ground for corporations to come in and run the NHS
• It Isn’t about professional protection• It isn’t a model to try and avoid scrutiny or local democratic oversight
Areas requiring further clarification
• Getting the Interface between three ICPs needs to be resolved (GNTB into ICS Interface group ?)
• Role of the HWBB could develop• CCG resources to be aligned to the City• Partners contributions to the ICP need to be determined
NHS Long Term Plan (LTP) Goals (1)
The NHS Long Term Plan is a new plan for the NHS to improve the quality of patient care and health outcomes:
• A new service model for the 21st century– boosting out‐of‐hospital care– Emergency care services will also be expanded and reformed– Give patients more control over their own health and more personalised care when they need
it– digitally‐enabled primary and outpatient care– focus on population health
• More NHS action on prevention and health inequalities– To cut smoking– To reduce obesity– To limit alcohol related A&E admissions
• Further progress on care quality and outcomes– Children and young people– Better care for major health conditions including cardiovascular and respiratory conditions,
learning disability and autism.
NHS Long Term Plan (LTP) Goals (2)
• NHS staff will get the backing they need– A comprehensive new workforce implementation plan– Expanding the number of nurses, midwives, AHPs and other staff– Growing the medical workforce– International recruitment– Supporting our current NHS staff– Enabling productive working– Leadership and talent management– Volunteers
• Digitally‐enabled care will go mainstream across the NHS• Taxpayers’ investment will be used to maximum effect
– Test 1: The NHS (including providers) will return to financial balance– Test 2: The NHS will achieve cash‐releasing productivity growth of at least 1.1% per year– Test 3: The NHS will reduce the growth in demand for care through better integration and
prevention – Test 4: The NHS will reduce unjustified variation in performance– Test 5: The NHS will make better use of capital investment and its existing assets to drive
transformation
• Spare slides
Nottingham & Nottinghamshire Integrated Care System Map
Integrated Care System (“The System” – Notts)
– Overarching strategy and response to NHS Long Term Plan– Develop associated ICS outcomes framework – Single increasingly strategic commissioner– Consistent Clinical Strategy & Standards– Develop Population Health management model and associated data / analytic capabilities
– Work with national agenda around workforce – Responsibility for system financial balance (Long Term Plan)
Integrated Care Partnership(“The Place” – Nottingham City)
– Citywide Partnership of all Health & Social Care Providers inc CVS
– Also has local ( tactical) commissioning capabilities– Bring providers and health and social care towards operating as one unit with set of aligned incentives
– Implement ICS strategy and response to LTP– Locally deliver ICS outcomes framework – but set City priorities
– Working to improve health outcomes and critically for the City reduce inequality
– Support to PCNs to deliver this
What actually will they do ?
The immediate ‘Asks’ in 19/20
ICS ‐ Improve Urgent Care performance‐ Financial Balance‐ Focus on Mental Health
ICP ‐ Demonstration of effectiveness as a “place”‐ Delivery of services – with local intelligence‐ Quality Improvement activity to support ICS strategy – via central transformation funding
PCNs ‐ Establish PCNs‐ identify development needs ‐ develop and start to deliver vision
What is the asks for PCNs / ICPs beyond 19/20?
• Plethora of guidance, inference and assumptions!• How do we make sense of all this?
• National – NHS Long Term Plan• National – regulator asks • Local – ICS priorities and outcomes framework• Local – ICP expectations of PCNs supporting place • NHS England/Improvement Ambitions and Expectations of
PCNs
ICS Priorities & Enablers